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COVID-19 mortality in women and men in sub-Saharan Africa: a cross-sectional study

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Jyoti Dalal, Isotta Triulzi, Ananthu James, Benedict Nguimbis, Gabriela Guizzo Dri, Akarsh Venkatasubramanian, Lucie Noubi Tchoupopnou Royd, Sara Botero Mesa, Claire Somerville, Giuseppe Turchetti, Beat Stoll, Jessica Lee, Abbate, Franck Mboussou, Benido Impouma, Olivia Keiser, Flávio Codeço Coelho

Abstract

Introduction Since sex-based biological and gender factors influence COVID-19 mortality, we wanted to investigate the difference in mortality rates between women and men in sub-Saharan Africa (SSA).

Method We included 69 580 cases of COVID-19, stratified by sex (men: n=43 071; women: n=26 509) and age (0–39 years: n=41 682; 40–59 years: n=20 757; 60+ years: n=7141), from 20 member nations of the WHO African region until 1 September 2020. We computed the SSA-specific and country-specific case fatality rates (CFRs) and sex-specific CFR differences across various age groups, using a Bayesian approach.

Results A total of 1656 deaths (2.4% of total cases reported) were reported, with men accounting for 70.5% of total deaths. In SSA, women had a lower CFR than men (mean Embedded Image = −0.9%; 95% credible intervals (CIs) −1.1% to −0.6%). The mean CFR estimates increased with age, with the sex-specific CFR differences being significant among those aged 40 years or more (40–59 age group: mean Embedded Image = −0.7%; 95% CI −1.1% to −0.2%; 60+ years age group: mean Embedded Image = −3.9%; 95% CI −5.3% to −2.4%). At the country level, 7 of the 20 SSA countries reported significantly lower CFRs among women than men overall. Moreover, corresponding to the age-specific datasets, significantly lower CFRs in women than men were observed in the 60+ years age group in seven countries and 40–59 years age group in one country.

Conclusions Sex and age are important predictors of COVID-19 mortality globally. Countries should prioritise the collection and use of sex-disaggregated data so as to design public health interventions and ensure that policies promote a gender-sensitive public health response.